Widmar M, Keskin M, Beltran P, Nash G M, Guillem J G, Temple L K, Paty P B, Weiser M R, Garcia-Aguilar J
Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
Hernia. 2016 Oct;20(5):723-8. doi: 10.1007/s10029-016-1518-2. Epub 2016 Jul 28.
Incisional hernia (IH) is a common complication after colectomy, with impacts on both health care utilization and quality of life. The true incidence of IH after minimally invasive colectomy is not well described. The purpose of this study was to examine IH incidence after minimally invasive right colectomies (RC) and to compare the IH rates after laparoscopic (L-RC) and robotic (R-RC) colectomies.
This is a retrospective review of patients undergoing minimally invasive RC at a single institution from 2009 to 2014. Only patients undergoing RC for colonic neoplasia were included. Patients with previous colectomy or intraperitoneal chemotherapy were excluded. Three L-RC patients were included for each R-RC patient. The primary outcome was IH rate based on clinical examination or computed tomography (CT). Univariate and multivariate time-to-event analyses were used to assess predictors of IH.
276 patients where included, of which 69 had undergone R-RC and 207 L-RC. Patient and tumor characteristics were similar between the groups, except for higher tumor stage in L-RC patients. Both the median time to diagnosis (9.2 months) and the overall IH rate were similar between the groups (17.4 % for R-RC and 22.2 % for L-RC), as were all other postoperative complications. In multivariable analyses, the only significant predictor of IH was former or current tobacco use (hazard raio 3.0, p = 0.03).
This study suggests that the incidence of IH is high after minimally invasive colectomy and that this rate is equivalent after R-RC and L-RC. Reducing the IH rate represents an important opportunity for improving quality of life and reducing health care utilization after minimally invasive colectomy.
切口疝（IH）是结肠切除术后常见的并发症，对医疗资源利用和生活质量均有影响。微创结肠切除术后IH的真实发病率尚无详尽描述。本研究旨在探讨微创右半结肠切除术（RC）后IH的发生率，并比较腹腔镜（L-RC）与机器人辅助（R-RC）结肠切除术后的IH发生率。
这是一项对2009年至2014年在单一机构接受微创RC患者的回顾性研究。仅纳入因结肠肿瘤接受RC的患者。排除既往有结肠切除术或腹腔内化疗史的患者。每例R-RC患者纳入3例L-RC患者作为对照。主要结局为基于临床检查或计算机断层扫描（CT）的IH发生率。采用单因素和多因素事件时间分析评估IH的预测因素。
共纳入276例患者，其中69例行R-RC，207例行L-RC。两组患者及肿瘤特征相似，但L-RC患者肿瘤分期较高。两组的中位诊断时间（9.2个月）和总体IH发生率相似（R-RC为17.4%，L-RC为22.2%），其他术后并发症发生率也相似。在多变量分析中，IH的唯一显著预测因素是既往或当前吸烟（风险比3.0，p = 0.03）。
本研究表明，微创结肠切除术后IH发生率较高，且R-RC和L-RC术后发生率相当。降低IH发生率是改善微创结肠切除术后生活质量和减少医疗资源利用的重要契机。
